When Ashley Phillips was referred to dermatologist Jennifer MacGregor by her primary doctor, Phillips was skeptical. Board-certified in dermatology and fellowship-trained in laser, cosmetic, and dermatologic surgery, MacGregor is both highly qualified and sought after as a care provider at Union Square Laser Dermatology in New York City. But as a trans woman looking to present more feminine, Phillips didn't understand how MacGregor could help her. "In the beginning, I said, 'Well, it's a dermatologist, what could she do?'" she recalls.

Phillips scheduled an appointment anyway. Six months later, the 39-year-old says the noninvasive treatments MacGregor has provided her have transformed her self-image, and she's eager to show other trans folks the potential of these procedures to alter gender presentation. "There are so many different things that she has done for my face that just amaze me," remarks Phillips.

She had assumed she could only achieve a more feminine look with facial feminization surgery, a set of surgical procedures that can include rhinoplasty, cheek implantation, or forehead reduction, but was surprised to discover other possibilities, thanks to the doctor. Phillips says, "From the first time that I saw [MacGregor], the Botox and the injectables just [on] the first day totally changed my whole outlook."

Phillips has also undergone CoolSculpting, a noninvasive procedure that freezes fat cells, and UltraShape, a body-contouring procedure through the use of ultrasound. "My body has changed so much that the confidence that I have now totally, totally is [blown] out of the water compared to what I used to go through before," she says. Recently, she ditched the bodysuit she had worn under her clothes since she began transitioning two years ago and went out in public wearing only a sports bra under her shirt.

It's very hard to find people in the healthcare profession that will listen to trans folks.

Injectables, CoolSculpting, and UltraShape are all popular treatments among cis, trans, and gender-nonconforming patients alike, and MacGregor stresses that none of the procedures she performs are "trans-specific." There are over 30 laser and energy devices at Union Square Laser Dermatology, she explains, as well as "a range of other procedures I offer to all of my patients."

"All people benefit by presenting themselves in the world...in the way that individual feels matches with what's on the inside," she continues. "Facial injectables can be tailored to masculinize, feminize, or really just customize an individual's goals: laser hair removal, laser resurfacing for acne (acne and scarring get especially [severe] in those taking testosterone) and surgical scars, and noninvasive body contouring for troublesome fat pockets or smoothing skin are also popular."

The cornerstone of caring for any patient, she adds, is listening: "One thing I've learned from all of my patients is never to assume what they want, what they see in the mirror, or what their goals might be," she says. "I simply ask what pronoun they [use], what facial and body hair pattern they prefer, what they see in the mirror they may wish to accentuate, minimize, and so on." As she points out, gender identity alone doesn't determine what a patient's priorities will be: Either trans or cis men may ask to remove beard hair, for example, while both trans and cis women may prefer the look of a stronger jawline.

I never assume what my patients want or what their goals are. I simply
ask what pronoun they use, what facial and body hair pattern they
prefer, what they wish to accentuate, minimize, and so on.

For transgender and gender-nonconforming people seeking care, this individualized, patient-led approach isn't universal in the medical world — or even all that common, unfortunately. "It's very hard to find people in the healthcare profession that will listen to trans folks," Phillips explains. "I've gone to doctors that misgender me…You go to some places and they tell you what they think you should have. I'm not saying Dr. MacGregor doesn’t give you suggestions, because she does, and they're amazing, but she’s also doing it based on what I feel."

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Many trans and gender-nonconforming folks, meanwhile, don't feel the need to undergo any procedures at all, invasive or otherwise. Others, like Armani Bowen, may opt for just one. While he's considered multiple masculinization procedures, Bowen decided to undergo only top surgery. The 29-year-old says that presenting traditionally masculine isn't his only priority, and while this doesn’t mean he’s satisfied with all of his features all of the time, he still concludes: "I don't want to blend in, I want to stand out."

All people benefit by presenting themselves in the world in the way that the individual feels matches with what's on the inside.

"Within anybody's transition — not even just trans people but within anybody's journey — you choose to make any changes to your body," he adds. "Nothing is a necessity. You don't have to change anything about yourself. Anything that you do is a choice."

His philosophy echoes MacGregor's: Trans people are not a monolith but individuals, deserving of sensitive, individualized care. It’s an obvious concept, but one some care providers still struggle to grasp.

"Last year, one of my transgender male patients came out to me with his transition and pointed out that many individuals in his community feel uncomfortable seeking care from a provider that hasn't specifically reached out to them or specialized in this area," MacGregor says. "He told me I was his only positive medical experience to date… I think many other dermatologists, like me, may not be aware of the barriers trans patients face in seeking out their care."

Her office, she hopes, is one place where these are barriers trans patients don't have to face.